The nurse plans care to prevent a dangerous thermal environment for an older adult client who lives in a northern climate of the United States. Which client assessment data does the nurse recognize that can contribute to the risk of hypothermia? (Select all that apply.)

Has a history of alcohol abuse

Bathes three to four times a week

Has a history of diabetes mellitus

Becomes diaphoretic on warm days

is prescribed antidepressant

Has a history of a cerebrovascular accident CVA

Answer and Explanation

Correct Answer : A,C,D,F

A. Has a history of alcohol abuse
Explanation: Alcohol can contribute to hypothermia as it causes vasodilation, leading to heat loss. It can impair the body's ability to regulate temperature.

B. Bathes three to four times a week
Explanation: While personal hygiene is important, the frequency of bathing alone may not be a direct risk factor for hypothermia. The overall environmental temperature and the individual's ability to regulate their body temperature are more critical considerations.

C. Has a history of diabetes mellitus
Explanation: Diabetes mellitus can increase the risk of hypothermia as it may affect circulation and peripheral nerve function. Impaired sensation and reduced blood flow can contribute to difficulty in maintaining body temperature.

D. Becomes diaphoretic on warm days
Explanation: Excessive sweating (diaphoresis) can contribute to the risk of hypothermia, as it leads to moisture loss from the skin, making it more challenging for the body to maintain a stable temperature.

E. Is prescribed antidepressant
Explanation: While certain medications, including some antidepressants, can affect thermoregulation, the prescription of an antidepressant alone does not necessarily indicate an increased risk of hypothermia. It is essential to consider the specific medication and its potential side effects.

F. Has a history of a cerebrovascular accident (CVA)
Explanation: Individuals with a history of a cerebrovascular accident may have impaired thermoregulation due to damage to the central nervous system. This can increase susceptibility to temperature extremes.

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Correct Answer is A

Explanation

A. Sub-acute care is more intensive than traditional nursing home care.

Explanation: Sub-acute care is generally more intensive and focused on providing specialized, short-term medical care and rehabilitation services. It is designed for individuals who require a higher level of care than what is typically provided in traditional nursing home settings.

B. Sub-acute care and nursing home care are identical.

Explanation: This statement is incorrect. Sub-acute care and nursing home care serve different purposes. Sub-acute care is typically provided for individuals recovering from acute medical conditions or surgeries, while nursing homes often cater to individuals with chronic illnesses or long-term care needs.

C. Sub-acute care is reimbursed by either Medicaid or private pay.

Explanation: This statement is not entirely accurate. Sub-acute care may be reimbursed by a variety of sources, including Medicare, private insurance, and, in some cases, Medicaid. The reimbursement sources can vary based on the specific circumstances and the services provided.

D. Professional nursing staff levels are the same as those in traditional nursing home settings.

Explanation: This statement is generally incorrect. Sub-acute care settings often have a higher ratio of skilled healthcare professionals, including nurses and therapists, compared to traditional nursing homes. This higher level of staffing is necessary to meet the more intensive medical and rehabilitation needs of sub-acute care patients.

A. Age-related motor deficiencies that result in self-neglect B. Age-related neurosensory changes that diminish awareness of temperature changes C. Delirium-related to an acute illness that is affecting body heat production D. Cognitive changes that diminish the individual's awareness of temperature changes

Correct Answer is B

Explanation

A. Age-related motor deficiencies that result in self-neglect.

Explanation: While age-related motor deficiencies could potentially impact a person's ability to dress appropriately, the specific scenario described (wearing a sweater despite high temperatures) is more indicative of sensory awareness issues rather than motor deficiencies.

B. Age-related neurosensory changes that diminish awareness of temperature changes.

Explanation: As individuals age, there can be neurosensory changes that affect their ability to perceive temperature accurately. This can result in older adults being less aware of changes in temperature, leading to behaviors such as dressing inappropriately for the weather. In this scenario, the client wearing a sweater despite the high temperature outside may be attributed to diminished awareness of the actual environmental temperature.

C. Delirium related to an acute illness that is affecting body heat production.

Explanation: Delirium may indeed affect a person's cognitive and functional abilities, but the scenario does not provide evidence of delirium or an acute illness. The focus is on the client's behavior related to dressing inappropriately for the weather, which is more suggestive of sensory awareness issues.

D. Cognitive changes that diminish the individual's awareness of temperature changes.

Explanation: This option is similar to the correct answer (Option B). Cognitive changes, particularly in awareness, can contribute to inappropriate dressing for the weather in older adults. The primary distinction here is that the term "neurosensory changes" in Option B specifically highlights alterations in sensory perception.

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The nurse plans care to prevent a dangerous thermal environment for an older adult client who lives in a northern climate of the United States. Which client assessment data does the nurse recognize that can contribute to the risk of hypothermia? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

An older client is being discharged from the hospital to a sub-acute unit. The client says to a nurse, "I am not sure I understand the difference between a sub-acute unit and a nursing home. Can you help me understand?" The nurse considers which of the following in formulating a response:

Correct Answer is A

Explanation

A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90°F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to what?

Correct Answer is B

Explanation

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The nurse plans care to prevent a dangerous thermal environment for an older adult client who lives in a northern climate of the United States. Which client assessment data does the nurse recognize that can contribute to the risk of hypothermia? (Select all that apply.)